You’ve been trying to get pregnant, but month after month you seem to be coming up empty. Well-meaning friends and family have started offering advice.

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Stand on your head after having sex, suggests your cousin. Chill out and relax, says your best friend. Adopt a baby and you’ll get pregnant, advises a coworker.

So, what are you to do? Infertility affects 15 to 20 percent of couples. Are you and your partner one of those couples? Most infertility issues can be successfully resolved with help from reproductive endocrinologists, but there are couples who, despite trying every advanced technology for infertility (and perhaps, out of desperation, every myth and superstition out there), just cannot have children. Luckily, this percentage is small.

Before either partner takes the blame, you should know that 40 percent of infertility is attributable to the woman and 40 percent is attributable to the man. The remaining 20 percent probably relates to a problem that involves both of you and therefore is harder to pinpoint.

It’s easy to play the blame game when it comes to infertility, but we recommend avoiding it because it only adds to the stress already present. It seems like simple advice, but we’ll give it anyway. Instead, support each other as you attempt to resolve any problems.

The main causes for female infertility include the following conditions:

Endometriosis

Over five million women in North America have endometriosis. It occurs when endometrial tissue – the tissue that lines the uterus – becomes implanted in portions of the pelvis where it doesn’t belong. It can implant anywhere, but the ovaries, fallopian tubes, uterus, and colon are among the most common sites.

The symptoms are as varied as the patients who have the disease. Many women experience no symptoms other than infertility, while others may have diffuse pelvic pain, pain with intercourse, and painful periods.

The degree of pain is not related to the amount of endometriosis present in the patient. Studies indicate that about 20 percent of women diagnosed with endometriosis cannot conceive without medical intervention.

If you have endometriosis and are having difficulty becoming pregnant, it could be that your fallopian tubes are partially or com­pletely blocked. Your physician may recommend a surgical proce­dure to open the tubes.

If your tubes are open but aren’t effectively” transporting the egg, then you might consider an assisted reproduc­tive technique (ART) such as intrauterine insemination (IUI) or in vitro fertilization (IVF). The IUI technique involves using medica­tion to stimulate the development of multiple eggs and timing ovu­lation.

Your partner’s semen is then implanted during ovulation into your uterine cavity through a hollow tube the diameter of a coffee straw. In IVF, your egg and your partner’s sperm are fertilized in a lab and then transferred to your uterus. Usually through one of these methods, endometriosis-related infertility can be overcome.

Ovulation Problems

During ovulation your ovaries are stimulated by a certain hor­monal milieu to release an egg. It occurs mid-cycle and is the first step in conception. Ovulation is essential in the regulation of men­strual periods as well as conception.

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Hormonal imbalances can result in certain conditions characterized by extremely irregular ovulation or lack of ovulation. A woman with polycystic ovarian syndrome (PCOS), for instance, will have difficulty conceiving due to irregular ovulation and irregular periods. Other common symptoms include excessive hair growth, acne, and weight gain.

Another hormonal issue is the overproduction of the hormone prolactin, made by the pituitary gland. Prolactin naturally increases during breastfeeding and plays a role in preventing pregnancy in women who breastfeed their babies during the first six postpartum months. If this hormone is elevated, it can cause irregular or absent ovulation.

Ovulation can also be affected if thyroid hormone levels are too high or too low.

Generally speaking, issues involving anovulation (no egg pro­duction) can be corrected. In the cases of polycystic ovarian syn­drome, women can be placed on Metformin, a drug used to treat dia­betes. It helps regulate ovulation by helping regulate insulin levels.

These women also may take the drug Clomid, which can help stim­ulate ovarian follicles to release an egg. If you are diagnosed with either increased prolactin production or thyroid irregularities, con­sult an endocrine specialist, who can recommend an appropriate treatment. Once these issues are corrected, ovulation and menstrual flow will become normal.

Blocked Fallopian Tubes

Multiple treatments are available to correct tubal factor infer­tility, which can result from endometriosis, pelvic inflammatory dis­ease, scarring from previous surgery, or, in rare instances, congenital factors. Tubal factor infertility is usually diagnosed by an outpatient radiology technique called hysterosalpingogram (HSG).

Dye is injected into the uterus and tracked with an x-ray as it flows into the fallopian tubes. The dye will accumulate in one spot if there is a blockage in the tube. Treatment for this type of infertility can involve surgery to remove the block or an assisted reproductive technique such as intrauterine insemination or in vitro fertilization.

Cervical Factor Infertility

Here, the infertility problem most likely involves a problem with the mucus in your cervix. The mucus could contain anti-sperm antibodies that destroy your partner’s sperm once they enter your cervix.

This situation can be diagnosed by performing a post-coital test at your doctor’s office within two to four hours of having sex with your partner. There, a cervical mucus specimen will be obtained and the mucus will be evaluated under a microscope for the presence of viable sperm.

If all of the sperm in the specimen are dead, further testing may be required to determine why this has occurred. A sperm penetra­tion test, for example, checks to see if sperm can move through cer­vical mucus; an anti-sperm antibody test will check for antibodies that destroy sperm once they enter the cervix. If there is a problem with cervical factor infertility, it usually can be resolved by intra­uterine insemination.